What is the appropriate dosing for Megace (Megestrol)?

From the Guidelines

The appropriate dosing for Megace (Megestrol) is 200-600 mg/d, with a suggested optimal dose between 400-800 mg/d.

Key Points

• The dosing range of 200-600 mg/d is based on the ASCO guideline for the management of cancer cachexia 1.
• A systematic review of 29 trials using progestins, including megestrol acetate, suggested that the optimal dose is between 480 and 800 mg per day 1.
• The minimum efficacious dose is 160 mg/day, but there is no evidence that doses greater than 480 mg/day have a higher efficacy 1.
• The NCCN guidelines recommend a dose of 400-800 mg/d for the treatment of anorexia/cachexia in patients with advanced cancer 1.

Benefits and Risks

• Megestrol acetate has been shown to improve appetite and weight gain in patients with cancer cachexia, but may increase the risk of edema, thromboembolism, and adrenal insufficiency 1.
• The benefits and risks of megestrol acetate should be carefully considered and monitored in patients with cancer cachexia.

Clinical Considerations

• Megestrol acetate can be used in combination with other interventions, such as dietary counseling and oral nutritional supplements, to manage cancer cachexia.
• The dose and duration of megestrol acetate should be individualized based on patient response and tolerance.
• Regular monitoring of patients receiving megestrol acetate is necessary to minimize the risk of adverse events and optimize treatment outcomes.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION The recommended adult initial dosage of megestrol acetate oral suspension, USP is 800 mg/day (20 mL/day). In clinical trials evaluating different dose schedules, daily doses of 400 and 800 mg/day were found to be clinically effective.

The appropriate dosing for Megace (Megestrol) is:

• Initial dosage: 800 mg/day (20 mL/day)
• Effective daily doses: 400 mg/day and 800 mg/day 2

From the Research

Appropriate Dosing for Megace (Megestrol)

The appropriate dosing for Megace (Megestrol) can vary depending on the patient population and the specific condition being treated.

• For cancer anorexia/cachexia, a study found that megestrol acetate was well tolerated and had a positive dose-response effect on appetite stimulation, with doses ranging from 160 to 1,280 mg/d 3.
• However, due to cost and inconvenience, the study suggests using 160 mg/d as the initial treatment dose for cancer anorexia/cachexia in routine clinical practice 3.
• Another study found that 80 mg twice daily after meals is an appropriate starting dose of megestrol acetate for anorexia in advanced cancer, with possible dose escalation if needed 4.
• For maintenance dialysis patients, a study found that megestrol acetate in a moderate dose of 400 mg/day was safe and improved nutritional state, inflammation, and anorexia 5.
• A randomized, double-blind, placebo-controlled trial compared megestrol acetate 480 mg/day with dexamethasone 4 mg/day for treating symptomatic anorexia in people with advanced cancer, and found that 79.3% of patients in the megestrol group responded to treatment at week 1 6.

Key Findings

• Megestrol acetate has a positive dose-response effect on appetite stimulation in cancer anorexia/cachexia patients 3.
• The initial treatment dose for cancer anorexia/cachexia is suggested to be 160 mg/d due to cost and inconvenience 3.
• A moderate dose of 400 mg/day may be effective for maintenance dialysis patients 5.
• Megestrol acetate 480 mg/day may be effective for treating symptomatic anorexia in people with advanced cancer 6.

Dosing Considerations

• Dosing regimens may vary depending on the patient population and specific condition being treated 3, 4, 5, 6.
• Possible side effects, such as altered mood and insomnia, should be considered when determining the appropriate dose 6.